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Eligibility and Coverage

 Health and Dental Care Plans

The MROO Health and Dental Care Program offers two plans to choose from, plus an optional Annual Travel Insurance Plan2. You and your spouse are eligible to enroll provided you:

2  See Annual Travel Insurance for full details regarding eligibility in the Annual Travel Insurance Plan.

It makes sense to enroll as soon as your employer benefits stop.

 Summary of Benefits

Health Care Plan  |  Health and Dental Care Plan

 Health Care Plan

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Coverage Description Maximums

Semi-private Hospital – pays the difference between the cost of ward and semi-private hospital accommodation while in Canada. If you are unable to obtain semi-private accommodation, the plan pays a benefit of $50 for each 24-hour period of ward hospitalization.

$5,000 per calendar year;

Prescription Drugs and Medicine – pays up to 90% of the combined cost of prescription drugs and dispensing fees with a written prescription from a physician or dentist and dispensed by a licensed pharmacist.100% coverage for eligible prescription drugs and dispensing fees under your MROO Health Care Plan when your prescriptions are filled by the Alliance Pharmacy Group. Dispensing fees are limited to $7 per prescription. With your ManuScript® card, you can submit your claims online quickly and easily.

Click here for an explanation of benefits co-ordination with the Ontario Drug Benefit Plan.

$2,200 per calendar year

Nursing Care – fees for private duty in-home registered nursing care when recommended by a physician.

Caregiver assistance available through YourNurse. Click here for more information.

$3,500 per calendar year

Ambulance Service – pays the cost of professional ground or air ambulance transportation to a hospital.

Unlimited ground and air transportation per calendar year

Orthopedic Shoes – one pair of orthopedic shoes is covered when prescribed by a physician or podiatrist.

$200 per calendar year

Vision Care – pays for prescription lenses and frames, contact lenses and laser eye surgery.

Supplementary/additional coverage is also included for expenses incurred (in excess of reimbursement by any government health care plan) for one optometrist visit within any consecutive 24-month period.

$250 per consecutive 24-month period

Hearing Aids – pays for the purchase or repair of prescribed hearing aids when initially required, or if required due to a change in prescription.

$500 per consecutive 36-month period

Medical Supplies and Prostheses – after reimbursement by any government plan, the plan will cover:

  • ostomy supplies
  • diabetic supplies
  • glucometer (lifetime maximum of one up to $400)
  • mastectomy brassieres (two per calendar year)
  • wigs as required due to chemotherapy treatment (lifetime maximum of $300)
  • prescribed orthotic appliances (maximum of $500 per calendar year)
  • oxygen, diagnostic laboratory services, radiology treatments including x-rays and radium therapy
  • artificial limbs or eyes, trusses, wheelchairs (lifetime maximum of $2,500), hospital beds, iron lungs, braces, canes, walkers, crutches, surgical stockings (four pairs per calendar year)
  • Continuous Positive Airway Pressure (CPAP) devices and supplies

$5,000 per calendar year

Diagnostic Services – pays the cost of one Prostate Specific Antigen (PSA) test per calendar year.

one per calendar year

Accidental Dental – within one year of the accident, the plan will pay the services of a dental surgeon for treatment of a fractured jaw or charges for repair or replacement of natural teeth due to an accidental external blow to the head.

$5,000 per calendar year

Psychologist – pays the fees of a clinical psychologist for up to $50 per visit.

$500 per calendar year

Paramedical Services – pays for fees incurred for visits to licensed practitioners. There is a $35 maximum per visit to a: physiotherapist, chiropractor, podiatrist, chiropodist, speech therapist, osteopath, naturopath, acupuncturist and masseur (if the treatments are recommended by a physician). For chiropractors, the plan also pays a $15 maximum for one x-ray per calendar year.

All paramedical fees are paid after you reach your provincial health plan limit.

$400 per specialty per calendar year

 Health and Dental Care Plan

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Health Care Plan

various coverage maximums

Dental Care – pays benefits based on the current year’s Dental Association Fee Guide for your province of residence.

Basic Dental Care – pays 80% of the cost for the following:

  • dental x-rays
  • minor restorative fillings
  • preventative care, which includes routine examinations and cleanings to a maximum of one treatment every six months
  • minor surgical benefits (includes extractions and oral surgical procedures)
  • periodontics (treatment of gums and mouth tissues)
  • endodontics (root canal therapy)
  • denture work, which includes repairs, rebasing and relining
  • consultation required by the attending dentist

Major Restorative Services – pays 50% of the fee charged for the following services:

  • inlays and crowns
  • dentures, bridgework, or dental implants as an alternate benefit up to the least expensive cost of a denture or bridge
  • denture adjustments

$1,500 per calendar year (combined Basic and Major Restorative)

Predetermination: If covered dental charges of more than $300 are to be incurred during any six-month period, prior approval must be obtained from Manulife.

 Exclusions

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The following prescription drug expenses are not eligible:

The following dental services are not eligible:

The following exclusions apply to all plans: